Randomized PCR-based therapy and risk factors for invasive fungal infection following reduced-intensity conditioning and haematopoietic stem cell transplantation

Ref ID: 18584

Author:

O. Blennow (1), M. Remberger (2), L. Klingspor (3),
B. Omazic (4), K. Fransson (4), P. Ljungman (5), J. Mattsson (4),
O. Ringdén (4)

Author address:

(1)Div of Infectious Diseases (Stockholm, SE); (2)Department
of Clinical Immunology and Transfusion Medicine (Stockholm,
SE); (3)Division of Clinical Bacteriology (Stockholm, SE);
(4)Center for Allogeneic Stem Cell Transplantation (Stockholm,

Full conference title:

Annual Meeting of the EBMT, 36th

Abstract:

Background: Invasive fungal infections (IFIs) are major complications after allogeneic hematopoietic stem cell transplantation
(HSCT). Polymerase chain reaction- (PCR-) based assays able
to detect DNA from Aspergillus and Candida species have been
reported to precede clinical diagnosis of IFI, enabling pre-emptive or early treatment. We performed a prospective study to
evaluate a PCR-based pre-emptive approach.
Methods: Ninety-nine patients undergoing reduced-intensity
conditioning (RIC) HSCT were followed once a week with fungal PCR during the fi rst 100 days post-transplantation. Patients
who tested positive were randomized to treatment with liposomal amphotericin B or to no treatment. After day 100, PCR
tests were performed only on clinical suspicion of IFI.
Results: Forty-one patients had at least one positive PCR
test (Aspergillus, n = 18; Candida, n = 29; both, n = 6). A single
positive PCR test was not associated with IFI irrespective of
whether or not there had been administration of pre-emptive liposomal amphotericin B. After day 100, PCR tests for
Aspergillus did not contribute to diagnosis of proven or probable S223
invasive aspergillosis (IA). The cumulative incidence rates of
proven or probable IFI, IA, and invasive candidiasis during the
fi rst year after transplantation were 12%, 9%, and 2%, respectively. Acute graft-versus-host disease (GVHD) of grades II
CIV (P = 0.0014), CMV-seronegative recipient with CMV-seropositive donor (P8804; 0.001), and conditioning with alemtuzumab
(P = 0.014) were signifi cant risk factors for developing IA in a
multivariate model.
Conclusions: PCR of peripheral blood is a poor predictor of
invasive fungal infection after allogeneic HSCT.

Abstract Number: P756

Conference Year: 2010

Link to conference website: NULL

New link: NULL

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